What is the prognosis of poststreptococcal glomerulonephritis?

Updated: Dec 16, 2020
  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In children, the immediate prognosis is excellent. [4]  Early death is extremely rare in children (< 1%) but is significantly more common in adults (25%). This is secondary to congestive heart failure and azotemia. Congestive heart failure is more common in adults (43%) than in children (< 5%). Nephrotic-range proteinuria is also more common in adults (20%) than in children (4-10%). Approximately 83% of adults have azotemia, compared with 25-40% of children.

Six cohort studies report case fatality rates from APSGN, with three revealing a case fatality rate of 0%, two studies from India reporting a case fatality rate of 1.4% and 2%, and one study from Turkey reporting a case fatality rate of 0.08%. [12]

The long-term prognosis is debatable. Fewer than 1% of children have elevated serum creatinine values after 10-15 years of follow-up. Adults who develop massive proteinuria often have the garlandlike pattern of immune deposits. Their prognosis is worse; approximately 25% progress to chronic kidney disease.

The long-term prognosis of children with APSGN has been the subject of several studies. Pooled data of studies published prior to 2000 with 5- to 18-year follow-up indicate abnormal urinalysis in 17.4%, proteinuria in 13.8%, hypertension in 13.8%, and azotemia in 1.3%. [15]  A study from Australia demonstrated that APSGN can add to the burden of chronic kidney disease. [16]  Araki and colleagues reported a case in a 15-year old boy with Alport syndrome that accelerated to end-stage kidney disease 15 months after the onset of APSGN. [17]


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